Cutaneous Botryomycosis in Immunocompetent Patients: A Case Series.
Botryomycosis is a rare chronic suppurative bacterial infection of skin and viscera mostly reported in immunocompromised adults. Most of published literature on botryomycosis are case reports. Though morphological presentation of cutaneous botryomycosis has been described as nodules, sinus, abscesses, and ulcers discharging seropurulent exudates, sequential evolution of lesions is not clear. We report a series of three cases of cutaneous botryomycosis in immunocompetent patients (one child and two adults). Two cases had localized lesion, while adult male had lesions in a sporotrichoid distribution. In all cases the lesions evolved in the form of appearance of subcutaneous swelling which later on developed multiple nodules and papules on surface which either developed erosion, ulceration or sinus on surface associated with seropurulent discharge. The organisms isolated from discharge and tissue culture were coagulase negative staphylococcus and methicillin sensitive staphylococcus aureus. All cases were treated with monotherapy of sensitive systemic antibiotic. Two patients fully recovered and one lost to follow-up in the middle of therapy.


Fatigue behavior of porous biomaterials manufactured using selective laser melting.
Porous titanium alloys are considered promising bone-mimicking biomaterials. Additive manufacturing techniques such as selective laser melting allow for manufacturing of porous titanium structures with a precise design of micro-architecture. The mechanical properties of selective laser melted porous titanium alloys with different designs of micro-architecture have been already studied and are shown to be in the range of mechanical properties of bone. However, the fatigue behavior of this biomaterial is not yet well understood. We studied the fatigue behavior of porous structures made of Ti6Al4V ELI powder using selective laser melting. Four different porous structures were manufactured with porosities between 68 and 84% and the fatigue S-N curves of these four porous structures were determined. The three-stage mechanism of fatigue failure of these porous structures is described and studied in detail. It was found that the absolute S-N curves of these four porous structures are very different. In general, given the same absolute stress level, the fatigue life is much shorter for more porous structures. However, the normalized fatigue S-N curves of these four structures were found to be very similar. A power law was fitted to all data points of the normalized S-N curves. It is shown that the measured data points conform to the fitted power law very well, R(2)=0.94. This power law may therefore help in estimating the fatigue life of porous structures for which no fatigue test data is available. It is also observed that the normalized endurance limit of all tested porous structures (<0.2) is lower than that of corresponding solid material (c.a. 0.4).


[Globalization, poverty and health].
This paper analyses the relationship between globalization, poverty and health, defining and presenting the main characteristics of contemporary globalization. It also establishes the characteristics of poverty today, both globally and regionally. Reviewing articles and world reports, it presents a set of evidence on the relationships between globalization and poverty, as well as their influence on health. Furthermore, it presents the opportunities offered by globalization, through a series of worldwide initiatives prompted by actions among countries under the aegis of the United Nations in general and the WHO in particular, in addition to intergovernmental alliances and coalitions and other civil society representatives.


The N-terminal extracellular domain is required for polycystin-1-dependent channel activity.
Autosomal dominant polycystic kidney disease (PKD) is caused by mutation of polycystin-1 or polycystin-2. Polycystin-2 is a Ca(2+)-permeable cation channel. Polycystin-1 is an integral membrane protein of less defined function. The N-terminal extracellular region of polycystin-1 contains potential motifs for protein and carbohydrate interaction. We now report that expression of polycystin-1 alone in Chinese hamster ovary (CHO) cells and in PKD2-null cells can confer Ca(2+)-permeable non-selective cation currents. Co-expression of a loss-of-function mutant of polycystin-2 in CHO cells does not reduce polycystin-1-dependent channel activity. A polycystin-1 mutant lacking approximately 2900 amino acids of the extracellular region is targeted to the cell surface but does not produce current. Extracellular application of antibodies against the immunoglobulin-like PKD domains reduces polycystin-1-dependent current. These results support the hypothesis that polycystin-1 is a surface membrane receptor that transduces the signal via changes in ionic currents.


Modulation by interferons of the expression of monocyte complement genes.
Interferons-alpha, -beta and -gamma (IFNs-alpha, -beta and -gamma) stimulated the synthesis of the second complement component (C2), Factor B (B) and C1 inhibitor (C1-inh) by human monocytes in vitro. The degree of increase of the secretion rates of C2, B and C1-inh was dose-dependent and proportional to increases in the abundances of their respective mRNAs. IFN-gamma was the most effective at stimulating monocyte C1-inh synthesis, whereas IFN-alpha and IFN-beta were marginally more effective at stimulating monocyte C2 and B synthesis. Kinetic studies showed that the effect of the IFNs was rapid, with maximum stimulation occurring within 1-2 h for all three proteins. After the removal of IFNs from cultures the C1-inh mRNA abundance remained elevated for over 24 h in IFN-gamma-treated monocytes but returned to control levels within 8 h in IFN-alpha-treated and IFN-beta-treated monocytes. The abundances of C2 mRNA and B mRNA also returned to basal values within 8 h after removal of any of the three cytokines from the cultures. Both IFN-alpha and IFN-beta acted synergistically with IFN-gamma to stimulate synthesis of C1-inh and B. This synergistic effect only occurred when the cytokines were present in the cultures simultaneously. The effects of IFN-gamma plus IFN-alpha or IFN-beta on C2 synthesis appeared to be additive rather than synergistic. IFN-gamma inhibited synthesis of C3 by monocytes, but IFN-alpha and IFN-beta had no effect on the synthesis of this protein. Furthermore, none of the three cytokines had any effect on the expression of actin mRNA in monocytes.


The applicability of proton transfer reaction-mass spectrometry (PTR-MS) for determination of isocyanic acid (ICA) in work room atmospheres.
A method is presented for the real-time quantitative determination of isocyanic acid (ICA) in air using proton transfer reaction-mass spectrometry (PTR-MS). Quantum mechanical calculations were performed to establish the ion-polar molecule reaction rate of ICA and other isocyanates. The PTR-MS was calibrated against different ICA air concentrations and humidity conditions using Fourier transform-infrared spectroscopy (FT-IR) as quantitative reference. Based on these experiments a simple humidity dependant model was derived for correction of the PTR-MS response for ICA. The corrected PTR-MS data was linearly correlated (R(2) > 0.99) with the data acquired by FT-IR. The PTR-MS instrumental limit of detection (LOD) for ICA was 2.3 ppb. Humid atmospheres resulted in LODs of 3.4 and 7.8 ppb, at an absolute humidity (AH) of 4.0 and 15.5 g m(-3), respectively. Furthermore, off-line sampling using denuder and impinger samplers using di-n-butylamine (DBA) as derivatization reagent was compared with PTR-MS measurements in a dynamically generated standard ICA atmosphere. Denuder (n = 4) and impinger (n = 4) sampling subsequent to liquid chromatography mass spectrometry (LC-MS) determination compared to corrected PTR-MS data resulted in recoveries of 79.6 (8.1% RSD) and 99.9 (9.3% RSD) %, respectively. Measurements of ICA from thermally decomposed cured 1,6-hexamethylene diisocyanate (HDI)-paint was performed using PTR-MS and denuder (n = 3) sampling. The relation between the average ICA responses using denuders (34.4 ppb) and PTR-MS (42.6 ppb) was 80.6%, which coincided well with the relative recovery obtained from the controlled laboratory experiments using dynamically generated ICA atmospheres (79.6%). The variability in ICA air concentration during the welding process (170% RSDPTR-MS) illustrated the need for real-time measurements.


Biomechanical properties of the lower uterine segment above and below the reflection of the urinary bladder flap.
To test the hypothesis that differences in the matrix arrangement of the lower uterine segment (above and below the reflection of the bladder flap) translate to differences in biomechanical or structural properties of the uterine wall. We enrolled prospectively 40 women at term randomized to a bladder flap (n=21) versus no bladder flap (n=19) at the time of a cesarean delivery for dystocia. Tensile properties of tissue biopsies from the upper and lower edges of the hysterotomy incision were quantitated using a stretching regimen designed to mimic labor. Parameters such as slope, yield point, and break point were analyzed in relationship to biochemical (total collagen, sulfated glycosaminoglycans, pyridinoline-deoxypyridinoline) and histological (collagen birefringence) properties of the tissue. The lower edge of the hysterotomy had a higher collagen content than the upper, independently of whether the hysterotomy site was above or below the reflection of the bladder (P<.001 for edge level, P=.8 for bladder flap). The pyridinoline-to-collagen ratio (a reflection of collagen cross-linking) was significantly decreased in the lower edge of the hysterotomy, independently of a bladder flap (P<.001). Neither collagen birefringence nor the amount of sulfated glycosaminoglycans differed among sites. There were no significant differences in biomechanical properties between the upper and lower edges of the hysterotomy, whether or not a bladder flap was created. The lower uterine segment of women with dystocia maintains its overall biomechanical properties despite significant quantitative and qualitative differences in fibrillar collagen between the upper and lower edge of the hysterotomy incision. II.


[Trans-scleral sutureless vitrectomy with a 25-G system for rhegmatogenous retinal detachment treatment].
The evaluation of the trans-scleral sutureless vitrectomy (TSV) efficiency using a 25G system as an alternative in rhegmatogenous retinal detachment (RRD) treatment. Patients treated for RRD with TSV have been reviewed taking into account their age, phakic or pseudophakic state, RRD localization and extension, surgical technique and post-operative resolution. Twenty two eyes of 22 patients have been treated for RRD with TSV. The average age was 54.3 years. 50% of the eyes were phakic. Eight of the detachments were "macula-off" at the time of diagnosis. SF6 was used in 5 cases and air in the remainder. Retinopexia of the breaks was done with trans-scleral cryocoagulation in 13 cases, with laser endophotocoagulation in 6 cases, and with both methods in 3 cases. The average follow-up time was 6.8 months, and the main complications were cataracts in 7 of 11 phakic eyes (63.6%) and a new retinal detachment in 4 eyes (18.2%). The intraocular pressures were similar to those before surgery and in 18 cases (81.8%) the visual acuity was better. TSV is effective in the treatment of RRD but with some limitations like the need for a learning period and a high incidence of cataracts.


Mutations in the 3' non-coding region of a no-known vector flavivirus Yokose virus increased its replication ability in mosquito C6/36 cells.
Yokose virus (YOKV) is a bat-associated no-known vector flavivirus group member. We investigated the replication ability of YOKV in mosquito-derived C6/36 cells. YOKV grew in C6/36 cells, but its kinetics of YOKV was markedly slower than those of other mosquito-borne flaviviruses. Transmission electron microscopy indicated an extremely small number of viral particles in YOKV-infected C6/36 cells. Mosquito-borne Japanese encephalitis virus prM-E-bearing chimeric YOKV failed to propagate efficiently in C6/36 cells. We isolated C6/36-adapted YOKV and identified nucleotide mutations in the adapted YOKV. Mutations detected in the 3' non-coding region of the adapted YOKV were critical for the enhanced proliferation ability of the virus. Moreover, the growth of the original and adapted YOKV in C6/36 cells was remarkably increased by shifting the culture temperature from 28 to 36 °C. Thus, our results demonstrate the potential of YOKV to propagate in mosquito cells and support its classification as a mosquito-borne flavivirus.


Olfactory dysfunction in hereditary ataxia and basal ganglia disorders.
In the present study the olfactory system of hereditary ataxia patients was tested using the smell identification test. Two previous findings suggested a possible olfactory impairment in these patients. First, an olfactory dysfunction has been found in different neurodegenerative diseases, and second, human functional imaging has shown cerebellar activation during olfaction. As an initial approach to determine if cerebellar ataxia impairs the olfactory process, cerebellar ataxia patients, along with basal ganglia patients, were tested. The results show an olfactory deficit in both basal ganglia and hereditary ataxia patients. Further exploration of the olfactory capacities in hereditary ataxia is necessary to elucidate the specific nature of the deficits.


Role of morality in the experience of guilt and shame within the armed forces.
Despite advances in our understanding of mental health issues among military forces, a large proportion of military personnel continue to exhibit deployment-related psychological issues. Recent work has identified symptoms of guilt and shame related to moral injury as contributing significantly to combat-related mental health issues. This systematic scoping review explores the association between morality and symptoms of guilt and shame within military forces. A search of the literature pertaining to guilt, shame and morality within military samples was conducted. Nineteen articles were selected for review. There is strong evidence linking exposure to and the perceived perpetration of moral transgressions with experiences of guilt and shame. Critically, symptoms of guilt and shame were related to adverse mental health outcomes, particularly the onset of post-traumatic stress disorder (PTSD). No studies have explored moral judgment in conjunction with assessments of guilt or moral injury. These findings have important implications for the prevention and treatment of PTSD-related symptoms in military samples. By measuring moral judgment prior to deployment, it may be possible to predict the likelihood of incurring moral injuries and the development of associated symptoms. Early intervention programmes aimed at ameliorating guilt and shame are required to prevent the long-term development of deployment-related psychological distress.


Nutrition, Exercise, and Skin Integrity among Frail Older Adults in Taiwan.
The purpose was to determine the correlation between nutrition status and skin integrity in the frail older adult population. Participants (N = 94) in this cross-sectional study were recruited through convenience sampling from the neurology and geriatrics outpatient department at a regional teaching hospital in Northern Taiwan. Study tools included a Basic Participant Profile Fill-in Sheet, which assesses demographic and exercise habit; the Comorbidity Index; Skin Integrity Evaluation Chart; Mini-Nutritional Assessment-Short Form; and Taiwan International Physical Activity Questionnaire Form. Data were analyzed by independent-samples t tests, χ tests, linear regressions, and logistic regression analyses. Significant correlations were found among nutrition status, aging, and exercise habits, as well as between participants' demographics and their skin integrity. Logistic linear regression showed that the decline of skin integrity can be predicted by nutrition status. Exercise programs and a balanced diet should be planned for frail older adults, and their nutrition status should be monitored closely. Those with declining nutrition status should be provided with nutrition supplements. In addition, clinicians should evaluate the skin condition of frail older adults to prevent the development of pressure injuries.


Evidence for the Direct Effect of the NPFF Peptide on the Expression of Feeding-Related Factors in Spotted Sea Bass (Lateolabrax maculatus).
Neuropeptide FF (NPFF) is a family member of RF-amide peptides, which are suggested to be involved in the control of vertebrate feeding behavior. However, little is known about the effect of the NPFF peptide on feeding-related processes in basal vertebrates. In this study, four full-length cDNAs, npff, npffr1, npffr2-1, and npffr2-2, were cloned from spotted sea bass and characterized. The conserved NPFF peptide is biologically active because it functionally interacts with different receptors expressed in cultured eukaryotic cells to enhance CRE promoter activity. Tissue distribution analysis showed that the highest npff mRNA expression occurred in the telencephalon, hypothalamus, medulla, gonad and muscle, but the npffrs mRNAs were mainly distributed within the central nervous system (CNS). In situ hybridization (ISH) detected npff-expressing cells in several specific regions ranging across the telencephalon and midbrain to the hypothalamus. Incubation of the spotted sea bass conserved NPFF peptide significantly increased the expression of orexin (orx) and neuropeptide Y (npy) mRNA and decreased the expression of leptin (lep), somatostatin (ss), and cholecystokinin (cck) mRNA in brain cells. Similarly, the conserved NPFF peptide also heightened the expression of gastrin (gas), ghrelin (ghrl), and motilin (mtl) mRNA and significantly reduced the expression of cck mRNA in the intestine and stomach. Taken together, these data suggest that the NPFF peptide may play a stimulating role in regulating feeding-related processes in spotted sea bass.


Hospital expenditures and utilization: the impact of HMOs.
To determine whether hospital utilization and expenditures have declined more rapidly in metropolitan statistical areas (MSAs) with high health maintenance organization (HMO) penetration compared with MSAs with low HMO penetration. Levels and rates of change in hospital expenditures and hospital utilization in MSAs with varying levels of HMO penetration (1982 to 1996) were compared in a natural experiment. MSAs were grouped into 4 categories based on HMO penetration rates in 1996. Levels and rates of change in hospital admission rates, hospital inpatient days, emergency room visits, total expenditures per capita, and expenditures per adjusted inpatient day from 1982 to 1996 were compared. A first-difference multivariate model was evaluated for 1993 to 1996. At the MSA level, the rates of change in hospital utilization and hospital expenditures varied only modestly with the level of HMO penetration. Changes in hospital admission rates did not vary systematically with HMO penetration rates except in the 1993 to 1996 period, when MSAs with the highest HMO penetration had the largest decline. Reductions in hospital days per capita and expenditures per day did not vary systematically by level of HMO penetration. Emergency room days declined most rapidly in the MSAs with the highest HMO penetration in the 1982 to 1993 period and were similar in the 1993 to 1996 period. Hospital expenditures per capita showed the greatest association with managed care penetration. They averaged 1.6% slower annual growth in MSAs with high versus low HMO penetration in the 1982 to 1996 period. This national study using data from 1982 to 1996 suggests that the effects of HMO penetration on hospital expenditures and hospital utilization at the MSA level are small (generally less than 1% per year).


Severe Streptococcal Infection Following Cat Scratch.
Cats can transmit bacterial infections to humans through biting and scratching. Streptococcal infections in wounds caused by cat bites or scratches rarely have been reported in the literature. The case of severe streptococcal skin infection after a 2-day-old cat scratch of the right arm, elbow, and forearm in a 68-year-old woman is presented herein. Group A β-hemolytic streptococci (GABHS) was isolated from the wound of the patient as well as the oral cavity and claws of the cat; likewise, Escherichia coli also was isolated from the oral cavity and claws of the cat. She was successfully treated with intravenous tigecycline for 2 weeks at a starting dosage of 100 mg daily. Tetanus prophylaxis was performed. Complete remission was observed 3 weeks after beginning treatment. Follow-up visit at 32 months was negative for clinical manifestations. For the first time documented in the literature, GABHS were isolated from the wound of the patient and from the cat's oral cavity and claws.


Pediatric asthma incidence rates in the United States from 1980 to 2017.
Few studies have examined longitudinal asthma incidence rates (IRs) from a public health surveillance perspective. Our aim was to calculate descriptive asthma IRs in children over time with consideration for demographics and parental asthma history. Data from 9 US birth cohorts were pooled into 1 population covering the period from 1980 to 2017. The outcome was earliest parental report of a doctor diagnosis of asthma. IRs per 1,000 person-years were calculated. The racial/ethnic backgrounds of the 6,283 children studied were as follows: 55% European American (EA), 25.5% African American (AA), 9.5% Mexican-Hispanic American (MA) and 8.5% Caribbean-Hispanic American (CA). The average follow-up was 10.4 years (SD = 8.5 years; median = 8.4 years), totaling 65,291 person-years, with 1789 asthma diagnoses yielding a crude IR of 27.5 per 1,000 person-years (95% CI = 26.3-28.8). Age-specific rates were highest among children aged 0 to 4 years, notably from 1995 to 1999, with a decline in EA and MA children in 2000 to 2004 followed by a decline in AA and CA children in 2010 to 2014. Parental asthma history was associated with statistically significantly increased rates. IRs were similar and higher in AA and CA children versus lower but similar in EA and MA children. The differential rates by sex from birth through adolescence principally resulted from a decline in rates among males but relatively stable rates among females. US childhood asthma IRs varied dramatically by age, sex, parental asthma history, race/ethnicity, and calendar year. Higher rates in the 0- to 4-year-olds group, particularly among AA/CA males with a parental history of asthma, as well as changes in rates over time and by demographic factors, suggest that asthma is driven by complex interactions between genetic susceptibility and variation in time-dependent environmental and social factors.


Identification of an altered peptide ligand based on the endogenously presented, rheumatoid arthritis-associated, human cartilage glycoprotein-39(263-275) epitope: an MHC anchor variant peptide for immune modulation.
We sought to identify an altered peptide ligand (APL) based on the endogenously expressed synovial auto-epitope of human cartilage glycoprotein-39 (HC gp-39) for modulation of cognate, HLA-DR4-restricted T cells. For this purpose we employed a panel of well-characterized T cell hybridomas generated from HC gp-39-immunized HLA-DR4 transgenic mice. The hybridomas all respond to the HC gp-39(263-275) epitope when bound to HLA-DR4(B1*0401) but differ in their fine specificities. First, the major histocompatibility complex (MHC) and T-cell receptor (TCR) contact residues were identified by analysis of single site substituted analogue peptides for HLA-DR4 binding and cognate T cell recognition using both T hybridomas and polyclonal T cells from peptide-immunized HLA-DR4 transgenic mice. Analysis of single site substituted APL by cognate T cells led to identification of Phe265 as the dominant MHC anchor. The amino acids Ala268, Ser269, Glu271 and Thr272 constituted the major TCR contact residues, as substitution at these positions did not affect HLA-DR4(B1*0401) binding but abrogated T cell responses. A structural model for visualisation of TCR recognition was derived. Second, a set of non-classical APLs, modified at the MHC key anchor position but with unaltered TCR contacts, was developed. When these APLs were analysed, a partial TCR agonist was identified and found to modulate the HC gp-39(263-275)-specific, pro-inflammatory response in HLA-DR4 transgenic mice. We identified a non-classical APL by modification of the p1 MHC anchor in a synovial auto-epitope. This APL may qualify for rheumatoid arthritis immunotherapy.


RF-induced heating of capped and uncapped abandoned epicardial leads during MRI at 1.5 T and 3 T.
There is a paucity of data regarding the safety of magnetic resonance imaging (MRI) in patients with abandoned epicardial leads. Few studies have reported temperature rises up to 76 °C during MRI at 1.5 T in gel phantoms implanted with epicardial leads; however, lead trajectories used in these experiments were not clinically relevant. This work reports patient-specific RF heating of both capped and uncapped abandoned epicardial lead configurations during MRI at both 1.5 T and 3 T field strengths. We found that leads routed along realistic, patient-derived trajectories generated substantially lower RF heating than the previously reported worst-case phantom experiments. We also found that MRI at the head imaging landmark leads to substantially lower RF heating compared to MRI at the chest or abdomen landmarks at both 1.5 T and 3 T. Our results suggest that patients with abandoned epicardial leads may safely undergo MRI for head imaging, but caution is warranted during chest and abdominal imaging.Clinical Relevance- Patients with abandoned epicardial leads may safely undergo MRI for head imaging, but caution is warranted during chest and abdominal imaging.


On modeling center of foot pressure distortion through a medium.
The center of foot pressure (COP) is a commonly used output measure of the postural control system as it is indicative of the systems stability. A dense piece of foam, i.e., a sponge, can be used to emulate random environmental conditions that distort the ground reaction forces received and interpreted by the cutaneous sensors in the feet; thus introducing uncertainty into the control system. In this paper, the density and size of the sponge was selected such that a subject's weight did not cause full compression. In general, the COP is measured from the bottom of the sponge. As the sponge is used to distort ground reaction forces, it is reasonable then to assume that the COP signal would also be distorted. The use of other sensory information to identify state of balance, and compute necessary balance adjustments, is therefore required. In addition to a sponge, many different types of specialized footwear and inserts are used for people with peripheral neuropathy, such as diabetics. However, it is difficult to design diabetic footwear without a better understanding of the mechanical and physiological effects that different surfaces typical of outdoor terrains, such as a sponge, which cannot be predicted without the sense of the foot, have on balance. Therefore, the goal of this study was to investigate the change of the COP signal from the top and bottom of the sponge. Portable force sensing mats from Vista Medical were used to obtain the COP from the top and bottom of the sponge. The COP measured on the bottom of the sponge is not the same as the COP measured on the top, particularly in the medial-lateral direction. Several linear and nonlinear models were used to identify the unknown plant; i.e., the sponge. Overall, the nonlinear neural network method had superior performance when compared with the linear models. Thus, the results indicate that the signals from the top and bottom of the sponge are in fact different, and furthermore, they are nonlinearly related. A nonlinear mathematical model is proposed which describes COP distortion through a medium such as a sponge. Although the values for the model parameters determined were for a particular sponge, this study suggests that a neural network plant identification model may be applied to any medium other than the sponge; the information can then be used to determine how the balance control model is affected given the sensory information received.


Small intestinal plasma cells in coeliac disease.
Using a modified immunoperoxidase technique to achieve optimum staining and reproducible counts of plasma cells in paraffin embedded tissue, IgA, IgM, IgE, and IgG plasma cells were studied in small bowel biopsies from 20 controls, 23 untreated coeliac patients, 19 treated coeliac patients, and seven patients with Crohn's disease not involving duodenum or jejunum. In controls the ratio of the mean counts for IgA, IgM, IgE, and IgG plasma cells was 2.5:1:1:1 respectively. In patients with untreated coeliac disease, counts of all types of plasma cell were significantly increased approximately two-fold compared with controls although for IgG cells there was considerable overlap. The ratio of the mean plasma cell counts in the untreated coeliac patients was 3.5:1.5:2:1. Counts fell significantly after treatment with a gluten-free diet. There was no significant difference between counts in the controls and the Crohn's disease patients. The changes found in coeliac disease may simply be a non-specific response to mucosal damage. The increases in IgA and IgM plasma cells, however, suggest that the deposits of extracellular IgA and IgM observed in coeliac mucosa are locally produced, and the increase in IgE plasma cells raises the possibility that reaginic type hypersensitivity may be involved in coeliac disease.


The SQUIRE Guidelines: an evaluation from the field, 5 years post release.
The Standards for Quality Improvement Reporting Excellence (SQUIRE) Guidelines were published in 2008 to increase the completeness, precision and accuracy of published reports of systematic efforts to improve the quality, value and safety of healthcare. Since that time, the field has expanded. We asked people from the field to evaluate the Guidelines, a novel approach to a first step in revision. Evaluative design using focus groups and semi-structured interviews with 29 end users and an advisory group of 18 thinkers in the field. Sampling of end users was purposive to achieve variation in work setting, geographic location, area of expertise, manuscript writing experience, healthcare improvement and research experience. Study participants reported that SQUIRE was useful in planning a healthcare improvement project, but not as helpful during writing because of redundancies, uncertainty about what was important to include and lack of clarity in items. The concept "planning the study of the intervention" (item 10) was hard for many participants to understand. Participants varied in their interpretation of the meaning of item 10b "the concept of the mechanism by which changes were expected to occur". Participants disagreed about whether iterations of an intervention should be reported. Level of experience in writing, knowledge of the science of improvement and the evolving meaning of some terms in the field are hypothesised as the reasons for these findings. The original SQUIRE Guidelines help with planning healthcare improvement work, but are perceived as complicated and unclear during writing. Key goals of the revision will be to clarify items where conflict was identified and outline the key components necessary for complete reporting of improvement work.


[Asymptomatic bacteriuria in patients with diabetes mellitus].
The prevalence of asymptomatic bacteriuria and the relation of bacteriuria to pyuria, glycosuria and HbA1c in patients with diabetes mellitus were investigated. The study population included 110 diabetic patients and 100 healthy persons (control group). The ratio of bacteriuria was found as 25.5% (31.3% in women, 17.4% in men) in the diabetic group and as 9% (16% in women, 0% in men) in the control group. The prevalence of asymptomatic bacteriuria was significantly higher in the diabetic patients than in the control group (p less than 0.05). There was a significant relation between bacteriuria, pyuria and HbA1c levels (p less than 0.05). But, there wasn't any important correlation between bacteriuria and glycosuria.


A cross-sectional study of epidemiological factors related to road traffic accidents in a metropolitan city.
Traffic injuries are one of the major causes of morbidity in India. It involves human sufferings in terms of physical, emotional, and financial losses to the individual, family, and the country. A better insight into the epidemiological determinants will help prevent such injuries. To estimate the proportion of fatal and nonfatal accidents and to determine the epidemiological factors related to nonfatal accidents. It was a cross-sectional study carried out in a tertiary care hospital over a period of 6 months. A simple random sampling technique was used for the selection of sample size of 476. Nonfatal accident victims were interviewed. The proportion of nonfatal to fatal accidents was found to be 1.8:1. Around 72.9% of drivers did not use any safety measure while driving. Two-wheelers (39%) and light motor vehicles (28.3%) were mostly involved, 45% of drivers had speed more than 60 km/h. Obstacles in the road (41%), defective roads (36.5%), and poor street lighting (11.4%) were reported as contributing factors of the accident. Lower extremities and head neck and face were involved in 47.2% and 27.1% of cases, respectively. Around 40.4% of cases had a single-site fracture. Traffic injuries result from the interaction between agent, host, and environmental factors. Preventing these interactions is very well possible with little extra care given towards road safety and traffic behavior of individuals.


Mental health and well-being in the first year of the COVID-19 pandemic among different population subgroups: evidence from representative longitudinal data in Germany.
To examine potential deteriorations in mental health and well-being in the first COVID-19 pandemic year compared with the previous decade focusing on the following vulnerable subgroups in Germany: women with minor children in the household, those living without a partner, younger and older adults, those in a precarious labour market situation, immigrants and refugees, and those with pre-existing physical or mental health risks. Analyses of secondary longitudinal survey data using cluster-robust pooled ordinary least squares models. More than 20 000 individuals (aged 16+ years) in Germany. Mental Component Summary Scale (MCS) of the 12-item Short-Form Health Survey measuring mental health-related quality of life, single item on life satisfaction (LS). We find a decline in the average MCS in the 2020 survey that is not particularly striking in the overall time course, still resulting in a mean score below those of all preceding waves since 2010. We find no change in LS from 2019 to 2020 against the background of a general upward trend. Regarding vulnerability factors, only the results on age and parenthood are partially in line with our expectations. In 2020, LS declined among the youngest adults; MCS declined among mothers (and women and men without children) but not fathers. Unlike respective comparison groups, refugees, those unemployed before the pandemic and those with pre-existing mental health risks experienced no MCS declines in 2020, whereas persons living without a partner, the eldest, and those with pre-existing health risks exhibited continued increases in LS. There is no evidence for substantial breakdowns in mental health or subjective well-being in the first pandemic year in the German population or its subgroups, particularly when considering developments of the previous decade. Since the majority of hypothesised vulnerable groups to pandemic stressors showed more stable MCS and LS, our results warrant further study.


Population-based study of first onset and chronicity in major depressive disorder.
There are no studies of the natural history of major depressive disorder that lack prevalence and clinic biases. To estimate risk factors for first lifetime onset and parameters of chronicity following the first episode, including duration, recovery, and recurrence, and to search for predictors of each parameter. Prospective population-based cohort study with 23 years of follow-up. East Baltimore, Maryland, an urban setting. Probability sample of 3481 adult household residents in 1981, including 92 with first lifetime onset of major depressive disorder during the course of the follow-up, and 1739 other participants followed up for at least 13 years. Diagnostic Interview Schedule and Life Chart Interview. Female participants showed higher risk of onset of disorder, longer duration of episodes, and a nonsignificant tendency for higher risk of recurrence. Sex was not related to recovery. The median episode length was 12 weeks. About 15% of 92 individuals with first episodes did not have a year free of episodes, even after 23 years. About 50% of first episode participants recovered and had no future episodes. The evolution of the course was relatively stable from first to later episodes. Individuals with 1 or 2 short alleles of the serotonin transporter gene were at higher risk for an initial episode, but experienced episodes of shorter duration. There were few strong predictors of recovery or recurrence. Major depressive disorder is unremitting in 15% of cases and recurrent in 35%. About half of those with a first-onset episode recover and have no further episodes.


Left atrial appendage occlusion.
Left atrial appendage occlusion (LAAO) is a first-line therapy for stroke prevention in patients suffering from atrial fibrillation (AF). While patients at high risk for bleeding or patients with previous bleeding have the highest relative risk reduction from LAAO, it is the younger patients with a high lifetime bleeding risk who benefit from the highest absolute risk reduction after LAAO. Therefore, LAAO should be discussed with every AF patient, as an alternative to lifelong oral anticoagulation. The patient needs to be informed about the risks and benefits of each treatment strategy in order to take an informed treatment decision.


Postpartum nutritional status of Filipino women.
Postpartum weight, body mass index (BMI), triceps skinfold thicknesses (TSF) and upper arm circumferences (AC) were measured bimonthly for 24 months in a large cohort of urban and rural Filipino women. Weight loss, leading to an increasing prevalence of low BMI (<18.5) is the norm in this population where dietary intakes of energy, calcium, and iron fall below WHO recommended intakes. The effects of lactation on postpartum changes in weight and TSF during 6-month intervals were examined by stratifying women into groups defined by lactation duration. In addition, multivariate models were used to examine the effects of lactation on changes in weight or TSF while controlling for other factors such as energy intake, seasonality, morbidity, pregnancy interval, parity, and age. Lactation was associated with significantly increased weight losses from birth to 18 months postpartum. Furthermore, full lactation (breast-feeding with the addition of less than 20 kcal/day to the infant's diet) also significantly increased weight loss in the first 6 months, when the overall duration of lactation in that interval was controlled. Lactation had a small but statistically significant effect on changes in TSF as well. © 1992 Wiley-Liss, Inc.


Modal Frustration and Periodicity Breaking in Artificial Spin Ice.
Here, an artificial spin ice lattice is introduced that exhibits unique Ising and non-Ising behavior under specific field switching protocols because of the inclusion of coupled nanomagnets into the unit cell. In the Ising regime, a magnetic switching mechanism that generates a uni- or bimodal distribution of states dependent on the alignment of the field is demonstrated with respect to the lattice unit cell. In addition, a method for generating a plethora of randomly distributed energy states across the lattice, consisting of Ising and Landau states, is investigated through magnetic force microscopy and micromagnetic modeling. It is demonstrated that the dispersed energy distribution across the lattice is a result of the intrinsic design and can be finely tuned through control of the incident angle of a critical field. The present manuscript explores a complex frustrated environment beyond the 16-vertex Ising model for the development of novel logic-based technologies.


Administration of Melatonin and Metformin Prevents Deleterious Effects of Circadian Disruption and Obesity in Male Rats.
Circadian disruption and obesity synergize to predispose to development of type 2 diabetes mellitus (T2DM), signifying that therapeutic targeting of both circadian and metabolic dysfunctions should be considered as a potential treatment approach. To address this hypothesis, we studied rats concomitantly exposed to circadian disruption and diet-induced obesity (CDO), a rat model recently shown to recapitulate phenotypical aspects of obese T2DM (eg, circadian disruption, obesity, insulin resistance, and islet failure). CDO rats were subsequently treated daily (for 12 wk) by timed oral gavage with vehicle, melatonin (a known chronobiotic), metformin, or combination treatment of both therapeutics. Melatonin treatment alone improved circadian activity rhythms, attenuated induction of β-cell failure, and enhanced glucose tolerance. Metformin alone did not modify circadian activity but enhanced insulin sensitivity and glucose tolerance. Importantly, the combination of melatonin and metformin had synergistic actions to modify progression of metabolic dysfunction in CDO rats through improved adiposity, circadian activity, insulin sensitivity, and islet cell failure. This study suggests that management of both circadian and metabolic dysfunctions should be considered as a potential preventative and therapeutic option for treatment of obesity and T2DM.


How diffusivity, thermocline and incident light intensity modulate the dynamics of deep chlorophyll maximum in Tyrrhenian Sea.
During the last few years theoretical works have shed new light and proposed new hypotheses on the mechanisms which regulate the spatio-temporal behaviour of phytoplankton communities in marine pelagic ecosystems. Despite this, relevant physical and biological issues, such as effects of the time-dependent mixing in the upper layer, competition between groups, and dynamics of non-stationary deep chlorophyll maxima, are still open questions. In this work, we analyze the spatio-temporal behaviour of five phytoplankton populations in a real marine ecosystem by using a one-dimensional reaction-diffusion-taxis model. The study is performed, taking into account the seasonal variations of environmental variables, such as light intensity, thickness of upper mixed layer and profiles of vertical turbulent diffusivity, obtained starting from experimental findings. Theoretical distributions of phytoplankton cell concentration was converted in chlorophyll concentration, and compared with the experimental profiles measured in a site of the Tyrrhenian Sea at four different times (seasons) of the year, during four different oceanographic cruises. As a result we find a good agreement between theoretical and experimental distributions of chlorophyll concentration. In particular, theoretical results reveal that the seasonal changes of environmental variables play a key role in the phytoplankton distribution and determine the properties of the deep chlorophyll maximum. This study could be extended to other marine ecosystems to predict future changes in the phytoplankton biomass due to global warming, in view of devising strategies to prevent the decline of the primary production and the consequent decrease of fish species.


Epigenetic Modifications and Their Potential Contribution to Traumatic Brain Injury Pathobiology and Outcome.
Epigenetic information is not permanently encoded in the DNA sequence, but rather consists of reversible, heritable modifications that regulate the gene expression profile of a cell. Epigenetic modifications can result in cellular changes that can be long lasting and include DNA methylation, histone methylation, histone acetylation, and RNA methylation. As epigenetic modifications are reversible, the enzymes that add (epigenetic writers), the proteins that decode (epigenetic readers), and the enzymes that remove (epigenetic erasers) these modifications can be targeted to alter cellular function and disease biology. While epigenetic modifications and their contributions are intense topics of current research in the context of a number of diseases, including cancer, inflammatory diseases, and Alzheimer disease, the study of epigenetics in the context of traumatic brain injury (TBI) is in its infancy. In this review, we will summarize the experimental and clinical findings demonstrating that TBI triggers epigenetic modifications, with a focus on changes in DNA methylation, histone methylation, and the translational utility of the universal methyl donor S-adenosylmethionine (SAM). Finally, we will review the evidence for using methyl donors as possible treatments for TBI-associated pathology and outcome.


Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children.
Most state Medicaid programs reimburse physicians for providing fluoride varnish, yet the only published studies of cost-effectiveness do not show cost-savings. Our objective is to apply state-specific claims data to an existing published model to quickly and inexpensively estimate the cost-savings of a policy consideration to better inform decisions - specifically, to assess whether Indiana Medicaid children's restorative service rates met the threshold to generate cost-savings. Threshold analysis was based on the 2006 model by Quiñonez et al. Simple calculations were used to "align" the Indiana Medicaid data with the published model. Quarterly likelihoods that a child would receive treatment for caries were annualized. The probability of a tooth developing a cavitated lesion was multiplied by the probability of using restorative services. Finally, this rate of restorative services given cavitation was multiplied by 1.5 to generate the threshold to attain cost-savings. Restorative services utilization rates, extrapolated from available Indiana Medicaid claims, were compared with these thresholds. For children 1-2 years old, restorative services utilization was 2.6 percent, which was below the 5.8 percent threshold for cost-savings. However, for children 3-5 years of age, restorative services utilization was 23.3 percent, exceeding the 14.5 percent threshold that suggests cost-savings. Combining a published model with state-specific data, we were able to quickly and inexpensively demonstrate that restorative service utilization rates for children 36 months and older in Indiana are high enough that fluoride varnish regularly applied by physicians to children starting at 9 months of age could save Medicaid funds over a 3-year horizon.


Increased mortality risk among the visually impaired: the roles of mental well-being and preventive care practices.
Mechanisms by which visual impairment (VI) increases mortality risk are poorly understood. We estimated the direct and indirect effects of self-rated VI on risk of mortality through mental well-being and preventive care practice mechanisms. Using complete data from 12,987 adult participants of the 2000 Medical Expenditure Panel Survey with mortality linkage through 2006, we undertook structural equation modeling using two latent variables representing mental well-being and poor preventive care to examine multiple effect pathways of self-rated VI on all-cause mortality. Generalized linear structural equation modeling was used to simultaneously estimate pathways including the latent variables and Cox regression model, with adjustment for controls and the complex sample survey design. VI increased the risk of mortality directly after adjusting for mental well-being and other covariates (hazard ratio [HR] = 1.25 [95% confidence interval: 1.01, 1.55]). Poor preventive care practices were unrelated to VI and to mortality. Mental well-being decreased mortality risk (HR = 0.68 [0.64, 0.74], P < 0.001). VI adversely affected mental well-being (β = -0.54 [-0.65, -0.43]; P < 0.001). VI also increased mortality risk indirectly through mental well-being (HR = 1.23 [1.16, 1.30]). The total effect of VI on mortality including its influence through mental well-being was HR 1.53 [1.24, 1.90]. Similar but slightly stronger patterns of association were found when examining cardiovascular disease-related mortality, but not cancer-related mortality. VI increases the risk of mortality directly and indirectly through its adverse impact on mental well-being. Prevention of disabling ocular conditions remains a public health priority along with more aggressive diagnosis and treatment of depression and other mental health conditions in those living with VI.


Light-responsive caffeine transfer through porous polycarbonate.
Light-responsive membranes based on a porous polycarbonate (PC) matrix were developed by surface functionalization with spirobenzopyran (SP)-containing polymers. The surface modification was generated by plasma-induced surface graft polymerization. Mass transfer rates of caffeine through these membranes were found to be up to eight times higher under UV irradiation than at daylight.


A role for ectophosphatase in xenobiotic resistance.
Xenobiotic resistance in animals, plants, yeast, and bacteria is known to involve ATP binding cassette transporters that efflux invading toxins. We present data from yeast and a higher plant indicating that xenobiotic resistance also involves extracellular ATP degradation. Transgenic upregulation of ecto-ATPase alone confers resistance to organisms that have had no previous exposure to toxins. Similarly, cells that are deficient in extracellular ATPase activity are more sensitive to xenobiotics. On the basis of these and other supporting data, we hypothesize that the hydrolysis of extracellular ATP by phosphatases and ATPases may be necessary for the resistance conferred by P-glycoprotein.


The use of socioeconomic factors in mapping tuberculosis risk areas in a city of northeastern Brazil.
In Brazil the challenge of meeting the needs of those living in deprived areas has generated discussions on replacing the existing approach to epidemiological surveillance with an integrated public health surveillance system. This new approach would supplant the traditional focus on high-risk individuals with a method for identifying high-risk populations and the areas where these persons live. Given the magnitude of the problem that tuberculosis (TB) poses for Brazil, we chose that disease as an example of how such a new, integrated public health surveillance system could be constructed. We integrated data from several sources with geographic information to create an indicator of tuberculosis risk for Olinda, a city in the Brazilian state of Pernambuco. In order to stratify the urban space in Olinda and to check for an association between the resulting TB risk gradient and the mean incidence of the disease between 1991 and 1996, we applied two different methods: 1) a "social deprivation index" and 2) principal component analysis followed by cluster analysis. Our results showed an association between social deprivation and the occurrence of TB. The results also highlighted priority groups and areas requiring intervention. We recommend follow-up that would include treating acid-fast bacilli smear-positive pulmonary TB cases, tracing of these persons' contacts, and monitoring of multidrug-resistant cases, all in coordination with local health services.


Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories.
Myocardial blood flow (MBF) obtained by dynamic CT perfusion (CTP) has been recently introduced to assess hemodynamic significance of coronary stenosis in coronary artery disease. The diagnostic performance of dynamic CTP MBF is limited due to subjective interpretation of MBF maps and MBF variations caused by physiological, methodological, and technical issues. In this paper, we introduce a novel method to quantify the hypoperfused volume (HPV) in myocardial territories derived from CT angiography (CTA) to overcome the limitations of current dynamic CTP MBF analysis methods. The diagnostic performance of HPV in classifying significant stenoses was evaluated on 22 patients (57 vessels) that underwent CTA, CTP and invasive fractional flow reserve (FFR). FFR was used as the standard of reference to determine stenosis significance. The diagnostic performance was compared to that of the mean MBF computed in regions manually annotated by an expert (MA-MBF). HPV was derived by thresholding the MBF in myocardial territories constructed from CTA by locating the closest artery. Diagnostic performance was evaluated using leave-one-case out cross-validation. Inter-observer reproducibility was assessed by performing annotations of coronary seeds (HPV) and manual regions (MA-MBF) with two users. In addition, the influence of different parameter settings on the diagnostic performance of HPV was assessed. Leave-one-case out cross-validation showed that HPV has an accuracy of 72% (58-83%) with sensitivity of 72% (47-90%) and specificity of 72% (58-83%). The accuracy of MA-MBF was 70% (57-82%) with a sensitivity of 50% (26-74%) and a specificity of 79% (64-91%). The Spearman correlation and the kappa statistic was (ρ = 0.94, κ = 0.86) for HPV and (ρ = 0.72, κ = 0.82) for MA-MBF. The influence of parameter settings on HPV based diagnostic performance was not significant. The proposed HPV accurately classifies hemodynamically significant stenoses with a level of accuracy comparable to the mean MBF in regions annotated by an expert. HPV improves inter-observer reproducibility as compared to MA-MBF by providing a more objective criterion to associate the stenotic coronary with the supplied myocardial territory.


Further studies of the chemical composition of the lipopolysaccharide of Pseudomonas aeruginosa.
1. Qualitative and quantitative analytical results for the lipopolysaccharide from acetone-dried cells of Pseudomonas aeruginosa (N.C.T.C. 1999) are presented and possible contamination of the material with nucleic acid was further examined. 2. Additional sugars detected (only in large-scale hydrolysates) were mannose and arabinose; traces of spermidine and putrescine were also found. 3. The heptose component is l-glycero-d-mannoheptose. 4. The thiobarbituric acid-positive component is a 3-deoxy-2-octulonic acid, of which only 35-40% links lipid A to the polysaccharide. This linkage is not broken by hydrolysis with acetic acid up to 0.08m. 5. Liberation of lipid A required hydrolysis with 0.1m-hydrochloric acid, which substantially degraded the polysaccharide moiety. 6. Fractions obtained from the degraded polysaccharide by high-voltage electrophoresis were examined; in these, the alanine/galactosamine molar ratio is approx. 1. 7. Hydrazinolysis of whole lipopolysaccharide showed that at least 40% of the alanine is in amide linkage, possibly with galactosamine. 8. Lipid A, solubilized by alkaline methanolysis was fractionated; most of the phosphorus of the higher-molecular-weight fractions was released as P(i) by a phosphomonoesterase. 9. Hydrazinolysis of lipid A destroyed approx. 80% of the glucosamine, and glycosidically linked glucosamine oligosaccharides could not be isolated.


[Comparative study of the reactogenicity and immunogenicity of new Soviet and commercial vaccines for preventing Japanese encephalitis].
In this article the results of testing Soviet vaccines for the prophylaxis of Japanese encephalitis, cell-culture inactivated adsorbed liquid vaccine and brain-tissue purified dried vaccine, are generalized and the comparison of their reactogenicity and immunogenicity characteristics with those of a similar commercial preparation manufactured by Toshiba Kagaku Kogyo Co., Ltd. (Japan) is made. Cell-culture inactivated liquid vaccine has proved to be the optimal preparation: it produces the most prolonged and intensive immunity and, when introduced by two methods, shows low reactogenicity.


Spatial supercontinuum generation in nonlinear photonic lattices.
We show that two Bloch modes launched into a nonlinear photonic lattice evolve into a comb or a supercontinuum of spatial frequencies, exhibiting a sensitive dependence on the difference between the quasi-momenta of the two initially excited modes. This phenomenon results from four-wave mixing combined with exchanges of momentum between the optical field and the lattice.


Exploiting sparsity to accelerate noncontrast MR angiography in the context of parallel imaging.
Noncontrast techniques for peripheral MR angiography are receiving renewed interest because of safety concerns about the use of gadolinium in patients with renal insufficiency. One class of techniques involves subtraction of dark-blood images acquired during fast systolic flow from bright-blood images obtained during slow diastolic flow. The goal of this work was to determine whether the inherent sparsity of the difference images could be exploited to achieve greater acceleration without loss of image quality in the context of generalized autocalibrating partially parallel acquisition (GRAPPA). It is shown that noise amplification at high acceleration factors can be reduced by performing subtraction on the raw data, before calculation of the GRAPPA weights, rather than on the final magnitude images. Use of the difference data to calculate the GRAPPA weights decreases the geometry factor (g-factor), because the difference data represent a sparse image set. This demonstrates an inherent property of GRAPPA and does not require the use of compressed sensing. Application of this approach to highly accelerated data from healthy volunteers resulted in similar depiction of large arteries to that obtained with low acceleration and standard reconstruction. However, visualization of very small vessels and arterial branches was compromised.


Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis.
To assess the efficacy of glucosamine sulfate in knee osteoarthritis (OA). A 4-center, 6-month, randomized, double-blind, placebo-controlled glucosamine discontinuation trial was conducted in 137 current users of glucosamine with knee OA who had experienced at least moderate improvement in knee pain after starting glucosamine. Study medication dosage was equivalent to the dosage of glucosamine taken prior to the study (maximum 1,500 mg/day). Followup continued for 6 months or until disease flare, whichever occurred first. The primary outcome was the proportion of disease flares in the glucosamine and placebo groups using an intent-to-treat analysis. Secondary outcomes included time to disease flare; analgesic medication use; severity of disease flare; and change in pain, stiffness, function and quality of life in the glucosamine and placebo groups. Disease flare was seen in 28 (42%) of 66 placebo patients and 32 (45%) of 71 glucosamine patients (difference -3%; 95% confidence interval [95% CI] -19, 14; P = 0.76). In the Cox regression analysis, after adjustment for sex, study site, and OA radiographic severity, time to disease flare was not significantly different in the glucosamine compared with placebo group (hazard ratio of flare = 0.8; 95% CI 0.5, 1.4; P = 0.45). At final study visit, acetaminophen was used in 27% and 21% of placebo and glucosamine patients, respectively (P = 0.40), nonsteroidal antiinflammatory drugs were used in 29% and 30% (P = 0.92), and both were used in 20% and 21% (P = 0.84). No differences were found in severity of disease flare or other secondary outcomes between placebo and glucosamine patients. In patients with knee OA with at least moderate subjective improvement with prior glucosamine use, this study provides no evidence of symptomatic benefit from continued use of glucosamine sulfate.


Proteus mirabilis pmrI, an RppA-regulated gene necessary for polymyxin B resistance, biofilm formation, and urothelial cell invasion.
Proteus mirabilis is naturally resistant to polymyxin B (PB). To investigate the underlying mechanisms, Tn5 mutagenesis was performed, and a mutant exhibiting increased PB susceptibility was isolated. The mutant was found to have Tn5 inserted into the PpmrI (Proteus pmrI) gene, a gene which may encode a UDP-glucuronic acid decarboxylase. In other bacteria, pmrI belongs to the seven-gene pmrF operon, which is involved in lipopolysaccharide (LPS) modification. While the PpmrI knockout mutant had a wild-type LPS profile and produced amounts of LPS similar to those produced by the wild type, LPS of the knockout mutant had higher PB-binding activity than that of the wild type. PB could induce alterations of LPS in the wild type but not in the PpmrI knockout mutant. Moreover, the PpmrI knockout mutant exhibited decreased abilities in biofilm formation and urothelial cell invasion. Complementation of the PpmrI mutant with the full-length PpmrI gene led to restoration of the wild-type phenotypic traits. Previously we identified RppA, a response regulator of the bacterial two-component system, as a regulator of PB susceptibility and virulence factor expression in P. mirabilis. Here we showed that RppA could mediate the induction of PpmrI expression by PB. An electrophoretic mobility shift assay further demonstrated that RppA could bind directly to the putative PpmrI promoter. Together, these results provide a new insight into the regulatory mechanism underlying PB resistance and virulence expression in P. mirabilis.


The use of translocatable genetic elements to construct a fine-structure map of the Klebsiella pneumoniae nitrogen fixation (nif) gene cluster.
The transposons Tn5, Tn7 and Tn10 and bacteriophage Mu have been used to derive insertion mutations in the Klebsiella pneumoniae nif gene cluster. A large number of deletion mutants have been derived by imprecise excision of insertion mutations and these deletions have been used to construct a fine-structure map of the nif cluster. Comparison of this genetic map with a physical map of the nif cluster derived by Reidel et al. (1979) showed a very good correlation between genetic and physical mapping methods. A new complementation group, designated nifU, has been identified and mapped between nifN and nifS. Polarity studies on the 14 nif cistrons now identified suggests that they are organized in at least seven transcriptional units and that all the multicistronic units are transcribed in the same direction.


Dissociation of nanosilicates induces downstream endochondral differentiation gene expression program.
Bioactive materials harness the body's innate regenerative potential by directing endogenous progenitor cells to facilitate tissue repair. Dissolution products of inorganic biomaterials provide unique biomolecular signaling for tissue-specific differentiation. Inorganic ions (minerals) are vital to biological processes and play crucial roles in regulating gene expression patterns and directing cellular fate. However, mechanisms by which ionic dissolution products affect cellular differentiation are not well characterized. We demonstrate the role of the inorganic biomaterial synthetic two-dimensional nanosilicates and its ionic dissolution products on human mesenchymal stem cell differentiation. We use whole-transcriptome sequencing (RNA-sequencing) to characterize the contribution of nanosilicates and its ionic dissolution products on endochondral differentiation. Our study highlights the modulatory role of ions in stem cell transcriptome dynamics by regulating lineage-specific gene expression patterns. This work paves the way for leveraging biochemical characteristics of inorganic biomaterials to direct cellular processes and promote in situ tissue regeneration.


Age-related differences in corticospinal excitability during a Go/NoGo task.
Age-related slowing of reaction times (RTs) is well documented but whether the phenomenon reflects deficits in movement preparation and/or response generation processes is unclear. To gain further insight into this issue, transcranial magnetic stimulation (TMS) was used to investigate motor cortex (M1) excitability and short-interval intracortical inhibitory (SICI) processes during a Go/NoGo RT task in younger and older adults. Single- and paired-pulse TMS was delivered over the left M1 during preparation and response generation periods in a right-hand muscle. Younger adults had shorter RTs and a larger increase in corticospinal excitability at response generation period than older adults. SICI modulation for both groups showed a large reduction in inhibition immediately prior to EMG onset. These findings indicate age-related differences in corticospinal excitability during the response generation stage of sensorimotor information processing.


[Homozygous familial hypercholesterolemia].
Familiar hypercholesterolemia (FH) is genetic disease characterized with extremely high levels of cholesterol leading to cholesterol deposition in skin and tissues and premature atherosclerosis due to defective LDL receptors. In homozygous individuals (HoFH) premature cardiovascular (CV) events and aortic stenosis could develop at very early ages due to the exposure of the vessels including aorta to high lipid levels since birth. Patients with HoFH do not respond to conventional antilipid agents including statins due to defective LDL receptors. Therefore,LDL apheresis is still the only choice of treatment in HoFH. However, in order to prevent both the development of CV events and aortic stenosis, regular apheresis should be initiated before the age of 10 years. With the knowledge of the 21.2% consanguineous marriages in Turkey, it could be suggested that the prevalence of FH is high in our country. However, the frequency of HoFH in Turkey is not known and there is limited data on prognosis in long term studies. This limited data denotes an extremely high mortality and morbidity in patients with HoFH. The main problem in these patients is late diagnosis leading to a delayed treatment. However, early diagnosis is the key factor for the prevention of premature atherosclerosis and for ensuring long-term survival in HoFH. Moreover, FH is a genetic disease that could be easily diagnosed with a detailed family history, physical examination, and assessment of lipid levels. In order to commence early diagnosis and early treatment, awareness of the physicians should be increased. Particularly raising the awareness among primary care physicians regarding high cholesterol levels in children and adolescents would be a substantial step. Public should realize that FH is a common disease with high mortality, and that the harms of high cholesterol begin in childhood. In order to achieve all these goals, National policy for the diagnosis and management of AH is warranted.


Study of Molybdenite Floatability: Effect of Clays and Seawater.
Current challenges in froth flotation are the presence of complex gangues and the use of low-quality waters, such as seawater. In this scenario, the recovery of molybdenum minerals is difficult, mainly due to the hydrophobic faces' physicochemical changes. In the present study, the natural floatability of pure molybdenite was analyzed by using microflotation assays, and hydrophobicity was measured by performing contact-angle measurements. The impact of two clays, kaolin (non-swelling) and Na-montmorillonite (swelling), was studied. The behavior in freshwater and seawater at pH 8 was compared, considering the current condition of the Cu/Mo mining industries, which use seawater in their operations. The presence of clays lowered the natural floatability of molybdenite precisely because they adhere to the surface and reduce its contact angle. However, the intensity with which they cause this phenomenon depends on the type of water and clay. Kaolin strongly adheres to the valuable mineral in both freshwater and seawater. For its part, Na-montmorillonite does it with greater intensity in a saline medium, but in freshwater, a high concentration of phyllosilicate is required to reduce the hydrophobicity of molybdenite. The clays' adherence was validated by scanning electron microscopy (SEM) analysis.


Actions of cromakalim on ionic currents recorded from single smooth muscle cells of the rat portal vein.
The effects of cromakalim (BRL34915), a novel K channel opener, on ionic currents in dispersed smooth muscle cells of the rat portal vein were investigated. Application of cromakalim (greater than 3 microM) generated an outward current, the reversal potential of which (-79 mV) was almost the same as the theoretical K equilibrium potential (-80 mV) under the experimental conditions used. When the Ca in the physiological salt solution (PSS) was replaced with Mn, the cromakalim-induced outward current was inhibited markedly. When 4 mM ethylene glycol bis(beta-aminoethyl ether(N,N'-N,N'-tetraacetic acid (EGTA) was added to the pipette solution (bath solution, Ca-free PSS + Mn), cromakalim inhibited the outward current evoked by command pulses. Using a pipette solution containing high Cs with 4 mM EGTA and a bath PSS containing 2.5 mM Ca with 1 microM tetrodotoxin, the Ca inward current was isolated. Cromakalim (greater than 3 microM) inhibited the Ca inward current in a voltage- dependent manner. Cromakalim (30 microM) inhibited the Ca inward current to 0.6 times the control. The decay of the inward Ca current comprised fast and slow components. Cromakalim inhibited the latter component and shifted the voltage-dependent inactivation curve of this current to the left (more hyperpolarized direction) in a parallel manner and delayed recovery from inactivation as estimated using a double pulse protocol. By using a pipette solution containing high Cs with 4 mM EGTA and Ca-free PSS containing 2.5 mM Mn in the bath, Na inward currents, blocked by tetrodotoxin (IC50 = 10 nM), were evoked by depolarizing pulses. Cromakalim (up to 30 microM) had no effect on the Na inward current.(ABSTRACT TRUNCATED AT 250 WORDS)


Physical Activity Among Foreign-Born Older Adults in Canada: A Mixed-Method Study Conducted in Five Languages.
Foreign-born older adults (FBOAs) are at risk for negative health transitions in Canada. Physical activity (PA) enhances health, yet we know very little about the PA habits of FBOAs in Canada. We conducted a mixed-method study in English, Cantonese, Mandarin, Punjabi, and Hindi, with 49 South Asian and Chinese FBOAs in Vancouver, Canada. In total, 49 participants completed surveys; of these 49, 46 wore accelerometers and 18 completed in-depth interviews. Participants' mean daily step count was 7,876 (women: 8,172, men: 7,164, Chinese: 8,291, and South Asian: 7,196). The bulk of their time is spent in light and sedentary activities. PA is principally acquired through walking for errands and work performed in and around the home. This study challenges the assumption that FBOAs are less active than their nonimmigrant peers and confirms the key role of "nonexercise" and low activity, rather than moderate to vigorous, in older adults' PA acquisition.


Thermal activation of methane by MgO+: temperature dependent kinetics, reactive molecular dynamics simulations and statistical modeling.
The kinetics of MgO+ + CH4 was studied experimentally using the variable ion source, temperature adjustable selected ion flow tube (VISTA-SIFT) apparatus from 300-600 K and computationally by running and analyzing reactive atomistic simulations. Rate coefficients and product branching fractions were determined as a function of temperature. The reaction proceeded with a rate of k = 5.9 ± 1.5 × 10-10(T/300 K)-0.5±0.2 cm3 s-1. MgOH+ was the dominant product at all temperatures, but Mg+, the co-product of oxygen-atom transfer to form methanol, was observed with a product branching fraction of 0.08 ± 0.03(T/300 K)-0.8±0.7. Reactive molecular dynamics simulations using a reactive force field, as well as a neural network trained on thousands of structures yield rate coefficients about one order of magnitude lower. This underestimation of the rates is traced back to the multireference character of the transition state [MgOCH4]+. Statistical modeling of the temperature-dependent kinetics provides further insight into the reactive potential surface. The rate limiting step was found to be consistent with a four-centered activation of the C-H bond, in agreement with previous calculations. The product branching was modeled as a competition between dissociation of an insertion intermediate directly after the rate-limiting transition state, and traversing a transition state corresponding to a methyl migration leading to a Mg-CH3OH+ complex, though only if this transition state is stabilized significantly relative to the dissociated MgOH+ + CH3 product channel. An alternative, non-statistical mechanism is discussed, whereby a post-transition state bifurcation in the potential surface could allow the reaction to proceed directly from the four-centered TS to the Mg-CH3OH+ complex thereby allowing a more robust competition between the product channels.


Orbital apex syndrome secondary to granulomatosis with polyangiitis.
Orbital apex syndrome (OAS) is an optic nerve dysfunction with palsy of the third, fourth and sixth cranial nerves and ophthalmic division of the fifth cranial nerve. Causes can be infective, inflammatory, traumatic, neoplastic or vasculitic. We describe the first case in British literature and second worldwide of OAS presenting as granulomatosis with polyangiitis (GPA). A 38-year-old patient presented with left periorbital swelling and pain. An examination revealed left eye proptosis, tenderness in the ophthalmic distribution of the trigeminal nerve, unilateral ophthalmoplegia and reduced visual acuity. Initial treatment included intravenous antibiotics, steroids and nasal decongestants.Imaging demonstrated sinusitis and a suspected abscess from the infratemporal fossa to the orbital apex. However, sinus surgery showed granulation tissue without pus. The biopsy result was highly suggestive of GPA. A subsequent vasculitic screen was cytoplasmic-antineutrophil cytoplasmic antibody positive.This case highlights an unusual presentation of OAS secondary to GPA, as initial features suggested an infective cause.


[A modified suture in the surgical treatment of middle ventral hernias].
Mechanical stability of the front abdominal wall median anatomic structure tissues has been examined in 49 experiments on cadavers. It was found that aponeurotic tissue of the edges of sheaths of the rectus abdominis is the most firm one. The article analyses different types of sutures used in hernioplasty. The authors propose original method of hernioplasty using the most stable anatomic structure, formation of narrow tissue duplication with a minimal amount of suture material. This method has been used in surgical treatment of 58 patients with umbilical, postoperative and linea alba hernias. There were no recurrences for 3 years.


Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations.
Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus. A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline. Five independent reviewers selected relevant articles. Quality of randomized trials was assessed according to the Jadad score and CONSORT statement. The level of evidence for each item was determined using the GRADE system. The Delphi method was used to validate the final recommendations. A total of 157 full texts were screened. Thirty-seven articles were included in the systematic review, and 16 of the 23 standard ERAS items were studied specifically for liver surgery. Consensus was reached among experts after 3 rounds. Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted. The use of postoperative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay. Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery. Early oral intake and mobilization are recommended. There is no evidence to prefer epidural to other types of analgesia. The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.


Interim results: influenza A (H1N1) 2009 monovalent vaccination coverage --- United States, October-December 2009.
In July 2009, the Advisory Committee on Immunization Practices (ACIP) issued recommendations for use of the influenza A (H1N1) 2009 monovalent vaccine. Recognizing that the vaccine supply would not be ample immediately but would grow over time, ACIP identified 1) initial target groups, consisting of approximately 160 million persons, and 2) a limited vaccine subset of the target groups, initially estimated at 42 million persons (and more recently estimated at 62 million persons), to receive first priority while the 2009 H1N1 vaccine supply was limited. ACIP recommended expanding vaccination to the rest of the population as vaccine supplies increased. To estimate 2009 H1N1 vaccination coverage to date for the 2009--10 influenza season, CDC analyzed results from the National 2009 H1N1 Flu Survey (NHFS) and the Behavioral Risk Factor Surveillance System (BRFSS) survey, conducted during December 27, 2009-January 2, 2010, and December 1-27, 2009, respectively. The results indicated that, as of January 2, an estimated 20.3% of the U.S. population (61 million persons) had been vaccinated, including 27.9% of persons in the initial target groups and 37.5% of those in the limited vaccine subset. An estimated 29.4% of U.S. children aged 6 months--18 years had been vaccinated. Now that an ample supply of 2009 H1N1 vaccine is available, efforts should continue to increase vaccination coverage among persons in the initial target groups and to offer vaccination to the rest of the U.S. population, including those aged >or=65 years.


Prediction of fluid responsiveness in severe preeclamptic patients with oliguria.
Because severe preeclampsia (SP) may be associated with acute pulmonary oedema, fluid responsiveness needs to be accurately predicted. Passive leg raising (PLR) predicts fluid responsiveness. PLR has never been reported during pregnancy. Our first aim was to determine the percentage of SP patients with oliguria increasing their stroke volume after fluid challenge. Our second aim was to assess the accuracy of PLR to predict fluid responsiveness in those patients. Patients with SP were prospectively included in the study. In the subgroup developing oliguria, transthoracic echocardiography was performed at baseline, during PLR and after a 500 ml fluid infusion over 15 min. Fluid responders were defined by a 15 % increase of stroke volume index. Five consecutive measurements were averaged for all parameters. Twenty-three (56 %) out of 41 patients with SP developed oliguria, 12 (52 %) out of these 23 responded to fluid challenge. During PLR, an increase of the velocity time integral of subaortic blood flow (ΔVTI) above 12 % predicted the response with a sensitivity and specificity of 75 [95 % confident interval (CI): 0.42-0.95] and 100 % (95 % CI: 0.72-1.00), respectively. An algorithm combining ΔVTI and the baseline value of VTI predicted fluid responsiveness with a sensitivity and specificity of 100 % (95 % CI: 0.74-1.00) and (95 % CI: 0.75-1.00). Urine output and respiratory variations of inferior vena cava diameter did not predict fluid responsiveness. Only 52 % of oliguric patients were responders. PLR accurately predicts fluid responsiveness in the specific setting of SP. This noninvasive test should be tested in future algorithms for the management of SP.


Folded alkyl chains in water-soluble capsules and cavitands.
A deep cavitand with ionic "feet" dimerizes around hydrophobic compounds in D2O. Longer n-alkane guests, C14-C18, are encapsulated in contorted conformations and NMR is used to deduce their shapes. Competition experiments establish the driving forces involved and how they compensate for the steric clashes in the folded structures of the encapsulated alkanes. Bolaamphiphiles instead prefer to bind in the monomeric cavitand with conformations that bury the methylenes but expose the polar head groups to solvent.


Forces exerted during spinal manipulative therapy.
Spinal manipulative therapy has been widely recognized in the medical fields as a conservative treatment modality for spinal dysfunction and pain. Spinal manipulative therapy consists of an application of a thrusting force on a specific part of the spine in a well-defined direction. The magnitude of this force has been associated with positive treatment effects, such as realigning vertebral bodies, mobilizing spinal joints, relaxing back musculature through reflex pathways, and producing a respiratory burst. However, direct force measurements during spinal manipulative therapy in a clinically relevant situation have not been performed to date. The purpose of this study was to measure the forces exerted onto patients during spinal manipulative therapy on various locations of the spinal column. Force measurements were obtained using a thin, flexible pressure mat. The results indicate that peak and preload forces are considerably smaller for spinal manipulative therapy performed on the cervical spine compared to corresponding values obtained on the thoracic spine and sacroiliac joint. Furthermore, for treatments on the thoracic spine and sacroiliac joint, a significant relation was found to exist between preload and peak forces.


Poxvirus infection in house finches (Haemorhous mexicanus): Genome sequence analysis and patterns of infection in wild birds.
Poxviruses (family: Poxviridae) infect many avian species, causing several disease outcomes, the most common of which are proliferative lesions on the legs, feet, and/or head. Few avian studies of poxvirus to date have combined molecular and ecological analyses to obtain a more comprehensive understanding of the identity and distribution of the disease in a population. Here, we describe patterns of poxvirus infection in an urban population of house finches (Haemorhous mexicanus) in Arizona (USA) and use high-throughput sequencing to determine the genome sequence of the virus. We found that poxvirus prevalence, based on visual identification of pox lesions, was 7.2% (17 infected birds out of a total of 235 sampled) in our population during summer 2021. Disease severity was low; 14 of the 17 infected birds had a single small lesion on the skin overlaying the eye, leg, and ear canal. All but two lesions were found on the feet; one bird had a lesion on the eye and the other in the ear opening. We also investigated possible temporal (i.e., date of capture) and biological correlates (e.g., age, sex, body condition, degree of infection with coccidian endoparasites) of poxvirus infection in urban-caught house finches during this time but found that none of these significantly correlated with poxvirus presence/absence. Two complete poxvirus genomes were determined from two infected birds. These genomes are ∼354,000 bp and share 99.7% similarity with each other, and 82% with a canarypox virus genome, the most closely related avipoxvirus. This novel finchpox virus is the first to be reported in house finches and has a similar genome organization to other avipoxviruses.


Rheumatoid-like arthritis in a lion tailed macaque.
Very few satisfactory models of rheumatoid arthritis (RA) exist in nonhuman species. It is particularly striking that nonhuman primates have only rarely been described to have disease processes resembling classic RA seen in humans. We describe the case of a lion tailed macaque (Macaca silenus), housed at the National Zoological Park in Washington DC, that had a polyarticular inflammatory arthropathy resembling RA. Gross and histopathologic examination of necropsy tissues and radiographic findings strongly suggest a rheumatoid-like disease, never before described in this species.


[Inorganic ion dynamics in the microspore and pollen grain of tobacco during the development of the male gametophyte].
We studied the dynamics of mobile potassium, chloride, and nitrate ions during development of the micro-spore and differentiation of the pollen grain in Nicotiana tabacum L. by measuring their concentration in aqueous extracts from cells destroyed by freezing-thawing using ion-selective electrodes. Stage-specific changes in the ion content and intracellular concentration in the male gametophyte were found. A relationship of the dynamics of ions to growth processes and changes in metabolic activity during gametophytogenesis has been discussed. The changes in the potassium and chloride ion concentrations have been interpreted as regulatory changes controlling protein synthesis in the pollen grain vegetative cell.


[The sclerocorneal trabeculum following cortisone treatment and perfusion of the anterior chamber with hyaluronidase (author's transl)].
Following perfusion of the anterior chamber with hyaluronidase, a great reduction in the basic substance of the sclero corneal trabeculum as well as increased activity of the goniocytes were observed with the electron microscope. The opening of the trabecular meshes thus produced constitutes a kind of chemical trabeculectomy, attributable to the depolymerization of the hyaluronates of the basic substance by the hyaluronidase of the goniocytes.


Measles outbreak in a poorly vaccinated region in Cameroon: a case series study, public health challenges and recommendations.
Measles is a highly contagious viral infection and still a leading cause of vaccine-preventable deaths in Africa; especially in unvaccinated populations. We reviewed the medical reports of the measles outbreak that occurred in Misaje, in the North west region of Cameroon from 11/03/2015 to 14/05/2015. Six measles cases were recorded during this period; three of them complicated by bacterial infections. Measles should be considered as a differential diagnosis for any febrile rash especially among poorly vaccinated populations. Primary preventive methods implemented by clinicians could help control outbreaks; especially with delays in public health intervention. Also, gaps in health policies in Cameroon should be addressed to scale up vaccination coverage in remote communities like Misaje to reduce the incidence of measles outbreaks.


Controlling the nanoscale rippling of graphene with SiO2 nanoparticles.
The electronic properties of graphene can be significantly influenced by mechanical strain. One practical approach to induce strain in graphene is to transfer atomically thin membranes onto pre-patterned substrates with specific corrugations. The possibility of using nanoparticles to impart extrinsic rippling to graphene has not been fully explored yet. Here we study the structure and elastic properties of graphene grown by chemical vapour deposition and transferred onto a continuous layer of SiO2 nanoparticles with diameters of around 25 nm, prepared on a Si substrate by the Langmuir-Blodgett technique. We show that the corrugation of the transferred graphene, and thus the membrane strain, can be modified by annealing at moderate temperatures. The membrane parts bridging the nanoparticles are suspended and can be reversibly lifted by the attractive forces between an atomic force microscope tip and graphene. This allows the dynamic control of the local morphology of graphene nanomembranes.


Plectin transcript diversity: identification and tissue distribution of variants with distinct first coding exons and rodless isoforms.
Plectin is a widely expressed protein that is very large in size and that has all the attributes of a multifunctional crosslinking and organizing element of the cytoskeleton. It displays a multidomain structure, versatile binding activities, and subcellular localizations that enable it to strengthen cells against mechanical stress forces. Moreover, hereditary gene defects in plectin cause epidermolysis bullosa simplex (EBS)-MD, a severe skin blistering disease with muscular dystrophy. Here we report the analysis of the exonintron organization of the rat plectin gene and the identification of several different isoforms on the transcriptional level. We show that of 35 coding exons identified, 4 serve as alternative first exons splicing into the same successive exon 2, which is the first of 7 exons encoding a highly conserved actin-binding domain. RNase protection mapping of transcripts containing 3 of the identified 4 alternate first exons revealed their coexpression in rat glioma C6 cells and in a series of different rat tissues that we examined. Significant variations in expression levels of first exons indicated the possibility of tissue-specific promoter usage. In addition, plectin splice variants lacking exon 31 (> 3 kb), which encodes the entire rod domain of the molecule, were identified in a variety of rat tissues. This study provides first insights into a complex plectin gene regulatory machinery with similarities to that of dystrophin.


Nutritional Therapies and Their Influence on the Intestinal Microbiome in Pediatric Inflammatory Bowel Disease.
Inflammatory bowel disease (IBD) is a chronic, autoimmune disorder of the gastrointestinal tract with numerous genetic and environmental risk factors. Patients with Crohn's disease (CD) or ulcerative colitis (UC) often demonstrate marked disruptions of their gut microbiome. The intestinal microbiota is strongly influenced by diet. The association between the increasing incidence of IBD worldwide and increased consumption of a westernized diet suggests host nutrition may influence the progression or treatment of IBD via the microbiome. Several nutritional therapies have been studied for the treatment of CD and UC. While their mechanisms of action are only partially understood, existing studies do suggest that diet-driven changes in microbial composition and function underlie the diverse mechanisms of nutritional therapy. Despite existing therapies for IBD focusing heavily on immune suppression, nutrition is an important treatment option due to its superior safety profile, potentially low cost, and benefits for growth and development. These benefits are increasingly important to patients. In this review, we will describe the clinical efficacy of the different nutritional therapies that have been described for the treatment of CD and UC. We will also describe the effects of each nutritional therapy on the gut microbiome and summarize the strength of the literature with recommendations for the practicing clinician.


Plasmonically Enhanced Reflectance of Heat Radiation from Low-Bandgap Semiconductor Microinclusions.
Increased reflectance from the inclusion of highly scattering particles at low volume fractions in an insulating dielectric offers a promising way to reduce radiative thermal losses at high temperatures. Here, we investigate plasmonic resonance driven enhanced scattering from microinclusions of low-bandgap semiconductors (InP, Si, Ge, PbS, InAs and Te) in an insulating composite to tailor its infrared reflectance for minimizing thermal losses from radiative transfer. To this end, we compute the spectral properties of the microcomposites using Monte Carlo modeling and compare them with results from Fresnel equations. The role of particle size-dependent Mie scattering and absorption efficiencies, and, scattering anisotropy are studied to identify the optimal microinclusion size and material parameters for maximizing the reflectance of the thermal radiation. For composites with Si and Ge microinclusions we obtain reflectance efficiencies of 57-65% for the incident blackbody radiation from sources at temperatures in the range 400-1600 °C. Furthermore, we observe a broadbanding of the reflectance spectra from the plasmonic resonances due to charge carriers generated from defect states within the semiconductor bandgap. Our results thus open up the possibility of developing efficient high-temperature thermal insulators through use of the low-bandgap semiconductor microinclusions in insulating dielectrics.


ApoE-2/E-3 ratio of very low density lipoprotein in diabetes mellitus.
Apolipoprotein E (apoE) of very low density lipoprotein (VLDL) in 22 diabetic patients was analysed by the method of one-dimensional isoelectrofocussing (IEF). We modified the IEF-method of Kashyap et al. by which apoE isoproteins were easily and accurately determined. The measurement of apoE-2/E-3 ratio was useful for determining apoE phenotypes. In 17 of 22 diabetics apoE phenotype was E3/3, while three patients showed E2/3 and two showed E3/4. ApoE-2/E-3 ratio was reduced from 0.91 +/- 0.07 to 0.73 +/- 0.04 (p less than 0.05) by the one month-period treatment in 10 insulin required diabetics. The ratio was also reduced from 1.06 +/- 0.14 to 0.89 +/- 0.09 (p less than 0.2) in 10 non-insulin required diabetics. The reduction in apoE-2/E-3 ratio was caused by an increase in apoE-3 band and a decrease in apoE-2 band which might be attributed to the changes in the sialic acid-content of isoproteins on the one-dimensional IEF method. Therefore, apoE phenotypes in diabetic patients should be determined when their diabetic state is improved.


Factors influencing community-led total sanitation (CLTS) implementation abandonment before achieving open defecation-free (ODF) status: case study of the Central-Western region of Burkina Faso.
Access to sanitation has become an important element for improving the health of populations in developing countries. In Burkina Faso, 12% of the population in rural areas has access to latrine and 65% practice open defecation (OD). In a bid to eliminate this unsanitary practice and enhance sanitation access in rural areas, the government embraced community-led total sanitation (CLTS) as a national strategy in 2014. However, more than 6 years later, a notable observation is the high abandonment rate, with only a small fraction of rural communities successfully eradicating OD. Out of the 8892 villages in the country, 3546 underwent a CLTS triggering from 2014 to 2020. Nevertheless, in 787 of these villages, the implementation of the CLTS approach was abandoned, indicating a substantial abandonment rate of 22.19%. Until now, most studies on CLTS have focused on the post-ODF phase, emphasizing the question of the sustainability of the results generated by the approach, as if the process from triggering to obtaining ODF certification was not subject to any problems. However, cases of abandonment of the CLTS process after triggering do exist, although poorly documented in the literature, and there are no studies that clearly assign responsibilities to the actors when CLTS implementation comes to be abandoned. This research aims to bridge these gaps by identifying the root causes of these abandonment cases while delineating the distinct responsibilities associated with these instances. To achieve this, the study was conducted in the Central-Western region of Burkina Faso, where all stakeholders involved in CLTS implementation, including target communities, were identified, their different roles in the process defined, and data collected through household surveys, interviews, and focus groups. The content analysis method was used to analyze the data. The research findings indicate that the abandonment of the CLTS implementation process is due to four categories of factors: sociocultural and economic aspects (39.78%), physical conditions (17.52%), governance aspects (26.28%), and the quality of approach implementation (16.42%). Moreover, these factors highlight a shared accountability for abandonment involving the government, implementing organizations, and target communities. These findings have significant implications for the future design of sanitation programs using the CLTS approach. To mitigate abandonment rates in the CLTS implementation process across rural communities, it is imperative for policymakers to attentively consider these factors and integrate the recommendations delineated in this study.


Endorphins: mechanism of acupuncture analgesia.
Discharges were recorded from spinal dorsal horn neurons in response to noxious skin heating (50 degrees C) in anesthetized cats. Repetitive electrical stimulation of the superficial peroneal (SP) and posterior tibial (PT) nerves inhibited these nociceptive discharges as well as systemic administration of met-enkephalinamide (synthetic endorphin). The inhibitory effects of electro-stimulation as well as administration of synthetic endorphin were partially but significantly antagonized by naloxone, thus arguing in favor of endogenous morphine release as the basis for the mechanism of acupuncture analgesia. However, non-responding neuronal units to the administration of enkephalin were also observed in the present study. These non-responding units may explain why acupuncture is not effective in some individuals.


[Ethical Dilemmas in Practice of Medicine Child].
After reviewing the existing bibliography in the last 20 years, we concluded that there is a lack of information regarding the ethical conflicts that affect to pediatrics in their daily practice. It produces certain degree of uncertainty in these professionals at the time of solving these problems. We made a systematic search in the main data bases, finding more than 150 articles related, of which 80 were considered outstanding. After studying them, we have found 40 ethical dilemmas, related to some principle of solution and that we described in this article. Through them we can find such important dilemmas as those related to physical disability, palliative care or consent from children.